ch.6 for PSYB32

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19 Jul 2010
! Psychoanalyst focus on the content of the phobia and see the phobic object as a symbol of an important unconscious
fear; content of phobia has important symbolic value
! Behaviourist ignore content of phobia and focus on function, for them the fears are equivalent in the means by which
they are acquired and in how they might be reduced and so on
Specific Phobias: unwarranted fears caused by the presence or anticipation of a specific object or situation
! DSM subdivides these phobias according to the course of the fear: blood, injuries and infection; situations; animals;
and natural environment
! fears can be groups into one of the 5 factors: 1) agoraphobia 2) fear of heights or water 3) threat fears 4) fears of being
observed 5) speaking fears
o these fears are then classified under two higher order categories: specific fears and social fears
! lifetime prevalence of specific phobias that involves specific objects was estimated at 7% in men and 16% in women
! specific fear focused on in a phobia can vary cross-culturally
o china: Pha-leng (fear of cold) related to yin and yang
o Japanese syndrome: taijinkyofusho (fear of other people)- not a social phobia but an extreme fear of embarrassing
others- encourages extreme concern for feelings of others yet discourage direct communication of feelings
Social Phobias are persistent, irrational fears linked generally to the presence of other people
! Extremely debilitating
! Individual try to avoid particular situations in which they might be evaluated fearing that they will reveal signs of
anxiousness or behave in an embarrassing way
! Speaking or performing in public, eating in public, using public lavatories and other activities carried out in the
presence of others can elicit extreme anxiety
! They can be either generalized or specific, depending on the range of situations that are feared and avoided
! Generalized social phobias involve many different interpersonal situations; these people have an earlier age of onset,
more comorbidity with other disorders such as depression and alcohol abuse and more severe impairment
! Specific social phobias involves intense fear often particular situation (e.g. public speaking)
! Social phobias are common with life time prevalence in NCR of 11% in men and 15% in women
! These phobias have high comorbidity rate with other disorders and often occur in conjunction with GAD, specific
phobias, panic disorders, avoidant personality disorder and mood disorders
! Onset generally takes place during adolescence when social awareness and interactions with others become more
important in a person’s life
! Students with it have lower self-esteem and distorted body image relative to students who are not phobic
! Social phobias are associated with marked dissatisfaction and low functioning in terms of quality of life and it was
actually linked with dropping out of school
! Predictors of recovery include being employed, no lifetime depression, fewer than three lifetime psychiatric disorders,
less psychopathology, less anxiety sensitivity, fewer daily hassles and better mental health
Psychoanalytic theories:
! According to Freud, phobias are defence against the anxiety produced by repressed id impulses; this anxiety is
displaced from the feared id impulse and moved to an object or situation that has some symbolic connection to it;
these objects or situations become the phobic stimuli and by avoiding them the person is able to avoid dealing with
repressed conflicts
! Phobias are the ego’s way of warding off a confrontation with the real problem, a repressed childhood conflict
! Example: lil Hans had not successfully resolved the Oedipal conflict therefore his intense fear so his father was
displaced on horses and he became phobic about leaving his home
! Arieti proposed that repression stems from a particular interpersonal problem of childhood rather than from an id
Behavioural Theories:
! Focus on learning as the way in which phobias are acquired
! Avoidance conditioning: phobic reactions are learned avoidance responses
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o Avoidance-conditioning formulation is based on two factor theory proposed by Mowrer, hold that phobias develop
from two related sets of learning
! Via classical conditioning- person can learn to fear a neutral stimulus (CS) if it is paired with an intrinsically
painful or frightening event (UCS)
! The person can learn to reduce this conditioned fear by escaping from or avoiding the CSoperant conditioning
(response maintained by its reinforcing consequence of reducing fear)
! Evidence demonstrates that only the possibility that some fears may be acquired in this particular way
! Pavlovian conditioning and observational learning via imitation can both play a role; by using “masked” stimuli that
observing another person’s fear response and not having explicit, conscious awareness of this conditioned stimulus
can still contribute to apparent learning of a fear response
! Fear is extinguished rather quickly when CS presented a few times without the reinforcement of moderate levels of
! A phobia of a specific object or situation has sometimes been reported after a particularly painful experience with that
! Some clinical reports suggest that phobias may develop without a prior frightening experience
o Modelling can help solve avoidance-conditioning model
! Some phobias can be acquired by modelling, not thru an unpleasant experience with the object or situation that is
feared" modeling is learning fear by imitating reactions of others
! Vicarious learning is the learning of fear by observing others; it can be accomplished thru verbal instructions
! Anxious-rearing model is based on premise that anxiety disorders in children are due to constant parental warnings
that increase anxiety in the child
o Prepared Learning: certain neutral stimulus called prepared stimuli, are more likely than others to become classically
conditioned stimuli may account for this tendency
! Some fears may well reflect classical conditioning, but only to stimuli to which an organism is physiologically
prepared to be sensitive
! Conditioning experiments that show quick extinction of fear may have used CSs that the organism was not
prepared to associate with USCs
! Prepared learning is also prevalence to learning fear by modelling
! Not every stimulus sis capable of becoming a source of acquired fear
o Diathesis is Needed: a cognitive diathesis (predisposition)a tendency to believe that similar traumatic experience
will occur in the futuremay be important in developing a phobia
o History of not being able to control the environment is another possible psychological diathesis
o Aversive conditioning experiences, such as severe teasing, have been proposed to play a role in the development of
social phobia
o Perceptions of teasing and bullying in childhood and social phobia
o While some phobias are learned thru avoidance conditioning, avoidance conditioning should not be regarded as a
totally validated theory; many people with phobias do not report either direct exposure to traumatic event or
exposure to fearful models
Social Skills Deficit in Social Phobias
! Behavioural model of social phobias considers inappropriate behaviour or lack of social skills as the cause of social
anxiety; Individual has not learned how to behave so that he or she feels comfy with others or the person repeatedly
commits fax pas, is awkward and socially inept and is often criticized by social companions
! Social skill deficit may have arisen over time because person was fearful of interacting with others for other reasons
such as classical conditioning and therefore had little experience doing so
Cognitive Theories
! Focus on how peoples thought processes can serve as a diathesis and on how thoughts can maintain a phobia
! Socially anxious people are more -concerned about evaluation, are more aware of the image they present to others and
are preoccupied with hiding imperfections and not making mistakes in front of other people- than are people who are
not socially anxious
! People with social phobia have a cognitive bias toward being more attentive visually to negative faces than to positive
faces, but no such bias is evident among people with OCD or in control participants
! Socially anxious people also seem to fear having a negative impact on other people; that is, they are worried about
causing discomfort in other people
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! Cognitive-behavioural models of social phobia link social phobia with certain cognitive characteristics 1) an
attentional bias to focus on negative social info 2) perfectionistic standards for accepted social performances 3) higher
degree of public self-consciousness
! Excessive social consciousness and self-focus tend to increase social anxiety
! Social phobia is linked with high self-criticism; this may underscore general sensitivity to perceived criticism
! Socially anxious students not only anticipate negative social experiences, they also engage in extensive post-event
processing of the negative social experiences, sometimes experiencing intrusive thoughts and images associated
typically with OCD
Predisposing Biological Factors
! Those that are adversely affected by stress have a biological malfunction (a diathesis) that somehow predisposes them
to develop a phobia following a particular stressful event
o Autonomic nervous system: people differ in their reaction to certain environmental situations in the ease with which
their ANS become aroused
! Stablilty-lability: labile, or jumpy, individuals are those whose ANS are readily aroused by a wide range of stimuli
! Autonomic labiality: tendency for ANS to be easily aroused
o Genetic Factors: since autonomic labiality is to some degree genetically determined, heredity may very well have a
significant role in the development of phobias
! Blood and injection phobia are strongly familial
! For both social and specific phobias, prevalence is higher than average in first degree relatives of patients
! Twin studies have also provided evidence that phobias have a heritable component and another shows that genetic
factors have a similar structure and role for men and women
! Inhibited children are more than 5 times more likely than uninhibited children to develop phobia later
Psychoanalytic Approaches:
! Attempt to uncover the repressed conflicts believed to underlie the extreme fear and avoidance characteristic of these
! Direct attempts to reduce phobic avoidance are contraindicated because the phobia is assumed to protect person from
repressed conflicts that are too painful to confront
! Contemporary ego analysts focus on encouraging patient to confront the phobia eventho they view the phobia as an
outgrowth of an earlier problem
! Many analytically oriented clinicians recognize the important of exposure to what is feared, although they usually
regard any subsequent improvement as merely symptomatic and not as a resolution of the underlying conflict that was
assumed to have produced the phobia
Behavioural Approaches:
! Systematic desensitization: individual imagines a series of increasingly frightening scenes while in a state of deep
relaxation; this technique is effective in eliminating, or at least reducing phobias
! In vivo exposure: exposure to real life phobic situations;
! Virtual reality (VR) exposure: just as effective as in vivo exposure and as effective as group CBT; it involves
exposure to stimuli that come in the form of computer-generated graphics; for social phobia it involves exposure to
four scenes that include performing in the presence of others and being scrutinized by others; it can be tailored to
involve graded exposures to threatening stimuli in hierarchy, similar to the increasingly frightening scenes used in
systematic desensitization
! Relaxation tends to make matters worse for people with blood-injection phobias because after the initial fright
(increase in heart rate and BP) a person with the phobia often experiences sudden drop in BP and heart rate and
faintstherefore by trying to relax people with these phobias, it may well contribute to the tendency to faint,
increasing their already high levels of fear and avoidance as well as embarrassment
o These patients are encouraged to be tensed rather than relax their muscles when confronting the fearsome situation
! Learning social skills can help people with social phobiaspatients are encouraged to role=play interpersonal
encounters in the consulting room or in a small therapy groupsuch practises may also expose the anxious person to
anxiety-provoking cues, such as being observed by others, so that extinction of fear thru real-life exposure takes place
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